medicinal meningitis. Symptoms and manifestations of meningitis, what causes it, what types are there, principles of treatment and prevention

In medicine, meningitis is an inflammatory process that takes place in the membrane of the brain, which is located between the cranium and the brain itself. It is transient and can lead to death in a few hours. At the same time, the incubation period of meningitis can last from 4 to 7 days, so everyone should know the first signs of this dangerous disease.

Disease classification

Meningitis is quite well studied and accurately classified. There are several types of this disease:

1. By the nature of the inflammatory process:

• purulent meningitis - the disease is caused by pathogenic bacteria (meningococcus), pus is formed, it is very severe;
• serous meningitis - caused by viruses (for example, enteroviruses, poliomyelitis viruses, mumps and others), is characterized by the absence of purulent contents in the area of ​​​​inflammation and a less severe course than in the previous form.

1. By the origin of the inflammatory process:

• primary meningitis - diagnosed as an independent disease, when examining the focus of infection in the patient's body is not detected;
• secondary meningitis - in the body there is a focus of infection, against which the inflammatory disease in question develops.

1. Due to the development of meningitis:

1. Depending on how quickly the inflammation develops:

• fulminant (fulminant) meningitis - develops very rapidly, all stages of progression pass almost instantly, the death of the patient occurs on the first day of the disease;
• acute meningitis - the development is not rapid, but fast - a maximum of 3 days to reach the peak of the disease and death of the patient;
• chronic - proceeds for a long time, the symptoms develop "increasingly", doctors cannot determine when meningitis has developed.

1. According to the localization of the inflammatory process:

• basal - the pathological process develops in the lower part of the brain;
• convexital - the localization of the inflammatory process occurs on the anterior (convex) part of the brain;
• spinal - pathology affects the spinal cord.

Reasons for development

The only reason for the development of the inflammatory process in the membranes of the brain is the penetration of infection into them. This can happen in different ways:

• airborne;
• oral-fecal - we are talking about the use of unwashed vegetables, fruits, berries;
• hematogenous - through the blood;
• lymphogenous - through the lymph.

And the causative agents of meningitis can be:

• pathogenic bacteria - tuberculosis and Escherichia coli, staphylo / streptococci, Klebsiella;
• viruses of different origin - herpes, mumps virus;
• fungi - candida;
• protozoa - amoeba and / or toxoplasma.

Factors that can provoke the development of the inflammatory process in question are:

• decreased immunity due to chronic diseases or forced long-term use of medications;
• chronic malnutrition;
• chronic fatigue syndrome;
• diabetes;
• peptic ulcer of the duodenum and stomach;
• AIDS virus.

Symptoms of meningitis in adults

Meningitis is characterized by severe symptoms, but the fact is that many of the signs go unnoticed or are removed by taking simple medications. And this not only “lubricates” the symptoms, but also makes it impossible to timely seek medical help. Symptoms of meningitis that should be a signal to seek immediate professional help:

1. Headache. This is generally considered the main symptom of meningitis, but this pain syndrome will have distinctive features:

• headache is constant;
• there is a feeling of fullness of the skull from the inside;
• the intensity of the pain syndrome increases when the head is tilted forward and backward, as well as when turning left and right;
• The meningitis headache gets worse with loud sounds and too bright colors.

1. Neck muscle tension. We are not talking about a convulsive syndrome, it’s just that a person cannot lie on his back in the usual position, he will definitely tilt his head back, because otherwise he experiences a strong pain syndrome.
2. Digestive disorder. This means that one of the signs of the inflammatory process in question in the membranes of the brain is nausea and vomiting. Note: vomiting will be repeated, even if the patient completely refuses food.
3. Hyperthermia. An increase in body temperature with meningitis is always accompanied by chills, general weakness and increased sweating.
4. Photophobia. A patient with a developing inflammatory process in the membrane of the brain is not able to look at a bright light - this immediately causes an acute headache.
5. Violation of consciousness. We are talking about a decrease in the level of consciousness - the patient becomes lethargic, answers questions slowly, and at a certain moment completely stops responding to the speech addressed to him.
6. Mental disorder. A person may experience hallucinations, aggression, apathy.
7. Convulsive syndrome. The patient may experience convulsions of the lower and upper extremities, in rare cases, against the background of convulsions, arbitrary urination and defecation appear.
8. Strabismus. If the optic nerves are affected during the progression of the inflammatory process, then the patient begins a pronounced strabismus.
9. Muscle pain.

Methods for diagnosing meningitis

Diagnosis of meningitis is a rather complicated and time-consuming process. After all, it is important not only to establish a diagnosis, but also to find out the degree of development, the type of meningitis, its localization and the pathogen that caused the onset of the inflammatory process in the membranes of the brain . Methods for diagnosing meningitis include:

1. Analysis of patient complaints:

• how long ago the symptoms of meningitis appeared;
• whether tick bites were noted in the recent past - some species of this insect are carriers of the causative agent of meningitis;
• whether the patient has been in countries where there are mosquitoes carrying meningococcal infection (for example, the countries of Central Asia).

1. Examination of the patient for a neurological condition:

• whether the patient is conscious and at what level it is - whether he reacts to the speech addressed to him, and if there is no reaction to the call, then they check the reaction to pain irritation;
• are there signs of irritation of the meninges - these include tension in the occipital muscles and headache with a feeling of fullness and photophobia;
• whether focal neurological symptoms are present - we are talking about symptoms of damage to specific areas of the brain: seizures of a convulsive nature with biting the tongue, weakness in the limbs, speech is impaired, there is asymmetry of the face. Please note: these signs indicate the spread of the inflammatory process from the meninges directly to the brain (encephalitis).

1. A laboratory study of the patient's blood - the analysis reveals signs of an inflammatory focus in the body: for example, the erythrocyte sedimentation rate will certainly be increased.
2. Lumbar puncture. The procedure is carried out only by a specialist and using a special long needle - it makes a puncture through the skin of the back at the lumbar level (subarachnoid space) and takes a little cerebrospinal fluid (maximum 2 ml) for analysis. It may contain pus or protein, which is a sign of an inflammatory process in the meninges.

Liquor is a fluid that provides metabolism and nutrition in the brain and spinal cord.

1. or magnetic resonance imaging of the head - the doctor can examine the meninges in layers and identify signs of their inflammation, which include the expansion of the ventricles of the brain and the narrowing of the subarachnoid fissures.
2. polymerase chain reaction. This is an analysis during which cerebrospinal fluid or blood is examined, which makes it possible for specialists to determine the causative agent of the disease and choose a truly effective treatment.

Principles of treatment of meningitis

Important:treatment of the considered inflammatory process in the meninges should be carried out only in a hospital - the disease develops rapidly and can lead to the death of the patient in a matter of hours. No folk methods will help to cope with meningitis.

The doctor immediately prescribes medications, namely broad-spectrum antibacterial drugs (antibiotics) - for example, macrolides, cephalosporins, penicillins. This choice is due to the fact that it is possible to establish the causative agent of the disease in question only when collecting and examining the cerebrospinal fluid - this process is quite long, and the patient needs to be helped on an emergency basis. Antibiotics are administered intravenously, and in the case of a serious state of health of the patient, directly into the cerebrospinal fluid. The duration of the use of antibacterial drugs is determined only on an individual basis, but even if the main signs of meningitis have disappeared and the patient's body temperature has stabilized, the doctor will continue to inject antibiotics for several more days.

The next direction in the treatment of the considered inflammatory process in the meninges is the appointment of steroids. Hormone therapy in this case will help the body cope with the infection faster and normalize the work of the pituitary gland.

Diuretics are also considered mandatory in the treatment of meningitis - they will relieve swelling, but doctors should take into account that all diuretics contribute to the rapid leaching of calcium from the body.

Patients undergo spinal puncture. This procedure alleviates the patient's condition because the cerebrospinal fluid exerts much less pressure on the brain.

Treatment of meningitis is always carried out against the background of vitamin therapy:

• firstly, it is necessary to support the body and help it resist infection;
• secondly, vitamins are needed to replenish the necessary macro / microelements that do not enter the body due to malnutrition.

Complications and consequences of meningitis

Meningitis is generally considered a life-threatening disease. Complications of this inflammatory process in the meninges are:

1. Cerebral edema. Most often, this type of complication develops on the second day of the disease. The patient suddenly loses consciousness (this happens against the background of the standard symptoms of meningitis), his pressure drops sharply, and after a while the pressure suddenly rises, the slow heartbeat is replaced by a rapid one (bradycardia turns into tachycardia), intense shortness of breath appears, all signs of pulmonary edema are clearly traced.

note: if medical care is not provided, then after a short time, meningitis symptoms completely disappear, the patient experiences involuntary urination and defecation, and death occurs due to paralysis of the respiratory system.

1. Infectious-toxic shock. This complication develops as a result of the decay and absorption into the cells and tissues of the body of a large number of decay products of the vital activity of pathogens. The patient's body temperature suddenly drops, the reaction to light and sounds (even not loud ones) becomes very sharp and negative, there is agitation and shortness of breath.

Note:infectious-toxic shock often passes against the background of cerebral edema. The death of the patient occurs within a few hours.

The consequences of meningitis can be epilepsy, deafness, paralysis, paresis, hormonal dysfunction and hydrocephalus. In general, any organs and systems of the body can be affected by meningococcal infection, so recovery from inflammation of the meninges lasts a very long time, and in some cases, a lifetime. Only immediate seeking help from doctors will help reduce the risk of complications and consequences of meningitis.

The first symptoms of meningitis are most often:

• high temperature (39-40 degrees);
• severe chills;
• headache;
• weakness;
• loss of appetite;
• excitement or, conversely, lethargy.

On the first or second day (against the background of headache and high temperature), a pink or red rash may appear, which begins with the feet and legs, gradually spreading higher and higher - to the very face. The rash resembles small bruises that disappear with pressure.

If you notice this symptom in yourself or in a patient, urgently call an ambulance, as this is a signal that sepsis is developing and in case of delay (without qualified medical assistance), the case can be fatal.

Also, watch out for a number of early symptoms of meningitis:

1. Stiffness of the neck (immobility) - the head is difficult or impossible to bend, the patient cannot reach his chest with his chin. This is one of the earliest signs.
2. Brudzinsky's symptoms - involuntary flexion of the legs (in the knee and hip joints) occurs when the head is tilted to the chest area.
3. Kernig's symptoms - legs bent at the knees do not straighten.
4. In young children, a large fontanel may swell.
5. Another characteristic symptom is that the patient turns to face the wall and covers his head with a blanket, while curling up in a ball position and throwing his head back.
6. In addition, it can be noted: blurred vision, double vision, confusion, hearing loss.

The first signs of meningitis by type

Primary

In primary meningitis, an acute infectious process occurs, which is caused by meningococcus. The trigger for the development of the disease is a weakened immune system caused by hypothermia and viral infections. In this case, the disease develops independently, without the occurrence of infectious processes in any organ. For example, bacteria can enter the body through the respiratory system.

How does primary meningitis start?:

• severe pain in the head;
• fever, chills;
• high body temperature;
• intolerance to light and sharp sounds;
• the appearance of a rash on the body;
• motor activity, which is often replaced by lethargy;
• loss of consciousness may occur;
• neck stiffness;
• sometimes there are convulsions.

Secondary

The disease occurs against the background of any infectious disease (after measles, mumps, syphilis, tuberculosis, pneumonia, sinusitis, tonsillitis, otitis, with skull injuries), and is often caused by pneumococci, less often staphylococci, streptococci, but also meningococci (as in case of primary meningitis).

• general weakness;
• malaise;
• dizziness;
• chills with fever;
• temperature increase up to 40 degrees;
• sharp pain in the head, which gradually increases;
• nausea and profuse vomiting;
• there are changes in the psyche;
• the patient refuses to eat and drink;
• children may experience an increase in head size;
• insomnia;
• hallucinations;
• in rare severe cases - coma.

Symptoms of primary and secondary disease may be similar. Only a doctor can establish the true form of meningitis and prescribe the appropriate treatment.

General symptoms

In addition to the above signs, which can occur both in primary and secondary meningitis, there are a number of symptoms characteristic of this disease.

General infectious signs of meningitis:

• pale skin;
• joint and muscle pain;
• nasolabial triangle cyanotic color;
• persistent feeling of thirst;
• lowering blood pressure;
• dyspnea;
• rapid pulse;
• Lesage symptom in children - when the child is held in the armpits (suspended), he bends his legs to his stomach;
• increased tactile sensitivity.

meningeal syndrome

it the first symptoms of the disease, which may be characterized by signs:

1. Severe bursting headache - occurs in all patients, and occurs due to increased intracranial pressure. The pain spreads throughout the head, and is not localized in any one place. In this case, patients may experience pressure on the eyes and ears. Analgesics do not give the desired effect - the pain does not go away.
2. Dizziness, "fountain" vomiting, fear of light and sound - these symptoms appear on the second or third day of the course of the disease. Vomiting, as a rule, occurs with an increase in headache and does not bring relief. Due to increased tactile sensitivity (against the background of irritation of the receptors of the meninges), the patient may experience pain even with a light touch on any of the skin areas.
3. In infants, there is a strong excitement and restlessness, diarrhea, frequent regurgitation, drowsiness and convulsions.

What to do in such a situation?

If you find symptoms of meningitis in yourself or your relative / friend, you should immediately call an ambulance to diagnose the disease and prescribe appropriate therapy. In severe forms of the disease, patients are hospitalized in the infectious diseases department of the hospital.

This is necessary for two reasons:

1. without inpatient treatment, the patient's condition can deteriorate significantly and lead to irreversible consequences (disability, death);
2. close relatives can also catch the infection.

This disease is treated by an infectious disease specialist. If the disease proceeds without pronounced symptoms (chills, fever), accompanied only by a headache, and the patient doubts that these are signs of meningitis, you can contact a neurologist.

However, if there is no certainty in the correct diagnosis, it is better to contact an infectious disease specialist or a therapist who will determine the subsequent tactics. It is pointless to take any painkillers - it will not help.

Inflammation of the membranes of the brain and spinal cord. Pachymeningitis - inflammation of the dura mater, leptomeningitis - inflammation of the pia and arachnoid meninges. Inflammation of the soft membranes is more common, in such cases the term "meningitis" is used. Its causative agents can be certain pathogenic microorganisms: bacteria, viruses, fungi; less common protozoal meningitis. Meningitis is manifested by severe headache, hyperesthesia, vomiting, stiff neck, typical position of the patient in bed, hemorrhagic skin rashes. To confirm the diagnosis of meningitis and establish its etiology, a lumbar puncture and a subsequent examination of the cerebrospinal fluid are performed.

General information

Inflammation of the membranes of the brain and spinal cord. Pachymeningitis - inflammation of the dura mater, leptomeningitis - inflammation of the pia and arachnoid meninges. Inflammation of the soft membranes is more common, in such cases the term "meningitis" is used. Its causative agents can be certain pathogenic microorganisms: bacteria, viruses, fungi; less common protozoal meningitis.

Etiology and pathogenesis of meningitis

Meningitis can occur through several routes of infection. Contact way - the occurrence of meningitis occurs in the conditions of an already existing purulent infection. The development of sinusogenic meningitis is facilitated by a purulent infection of the paranasal sinuses (sinusitis), otogenic - mastoid process or middle ear (otitis media), odontogenic - pathology of the teeth. open craniocerebral injury or spinal cord injury, crack or fracture of the base of the skull.

The causative agents of infection, entering the body through the entrance gate (bronchi, gastrointestinal tract, nasopharynx), cause inflammation (serous or purulent type) of the meninges and adjacent brain tissues. Their subsequent edema leads to disruption of microcirculation in the vessels of the brain and its membranes, slowing down the resorption of cerebrospinal fluid and its hypersecretion. At the same time, intracranial pressure rises, dropsy of the brain develops. It is possible to further spread the inflammatory process to the substance of the brain, the roots of the cranial and spinal nerves.

Classification of meningitis

Clinical picture of meningitis

The symptom complex of any form of meningitis includes general infectious symptoms (fever, chills, fever), increased respiration and disturbance of its rhythm, changes in heart rate (tachycardia at the onset of the disease, bradycardia as the disease progresses).

Meningitis is characterized by hyperesthesia of the skin and soreness of the skull during percussion. At the onset of the disease, there is an increase in tendon reflexes, but with the development of the disease they decrease and often disappear. In the case of involvement in the inflammatory process of the substance of the brain, paralysis, pathological reflexes and paresis develop. Severe meningitis is usually accompanied by dilated pupils, diplopia, strabismus, impaired control of the pelvic organs (in the case of the development of mental disorders).

Symptoms of meningitis in old age are atypical: a slight manifestation of headaches or their complete absence, tremor of the head and limbs, drowsiness, mental disorders (apathy or, conversely, psychomotor agitation).

Diagnosis and differential diagnosis

The main method for diagnosing (or excluding) meningitis is a lumbar puncture followed by a study of cerebrospinal fluid. This method is favored by its safety and simplicity, so lumbar puncture is indicated in all cases of suspected meningitis. All forms of meningitis are characterized by fluid leakage under high pressure (sometimes a jet). With serous meningitis, the cerebrospinal fluid is transparent (sometimes slightly opalescent), with purulent meningitis, it is cloudy, yellow-green in color. With the help of laboratory studies of cerebrospinal fluid, pleocytosis is determined (neutrophils in purulent meningitis, lymphocytes in serous meningitis), a change in the ratio of the number of cells and an increased protein content.

In order to determine the etiological factors of the disease, it is recommended to determine the level of glucose in the cerebrospinal fluid. In the case of tuberculous meningitis, as well as meningitis caused by fungi, glucose levels are reduced. For purulent meningitis, a significant (to zero) decrease in glucose levels is typical.

The main landmarks of a neurologist in the differentiation of meningitis are the study of cerebrospinal fluid, namely the determination of the ratio of cells, the level of sugar and protein.

Treatment of meningitis

In case of suspected meningitis, hospitalization of the patient is mandatory. In severe prehospital stage (depression of consciousness, fever), the patient is administered prednisolone and benzylpenicillin. Lumbar puncture at the prehospital stage is contraindicated.

The basis of the treatment of purulent meningitis is the early appointment of sulfonamides (etazol, norsulfazol) or antibiotics (penicillin). Allows the introduction of benzylpenicillin intralumbally (in an extremely severe case). If such treatment of meningitis during the first 3 days is ineffective, therapy with semi-synthetic antibiotics (ampicillin + oxacillin, carbenicillin) in combination with monomycin, gentamicin, nitrofurans should be continued. The effectiveness of such a combination of antibiotics has been proven before the isolation of a pathogenic organism and the detection of its sensitivity to antibiotics. The maximum duration of such combination therapy is 2 weeks, after which it is necessary to switch to monotherapy. The criteria for cancellation are also a decrease in body temperature, normalization of cytosis (up to 100 cells), regression of cerebral and meningeal symptoms.

The basis of the complex treatment of tuberculous meningitis is the continuous administration of bacteriostatic doses of two or three antibiotics (for example, isoniazid + streptomycin). With the appearance of possible side effects (vestibular disorders, hearing impairment, nausea), the abolition of this treatment is not required, a decrease in the dose of antibiotics and a temporary addition to the treatment of desensitizing drugs (difenhydramine, promethazine), as well as other anti-tuberculosis drugs (rifampicin, PASK, ftivazide). Indications for discharge of the patient: no symptoms of tuberculous meningitis, sanitation of cerebrospinal fluid (after 6 months from the onset of the disease) and improvement in the general condition of the patient.

Treatment of viral meningitis may be limited to the use of symptomatic and restorative agents (glucose, metamizole sodium, vitamins, methyluracil). In severe cases (pronounced cerebral symptoms), corticosteroids and diuretics are prescribed, less often - repeated spinal puncture. In the case of a layering bacterial infection, antibiotics may be prescribed.

Forecast

In the further prognosis, an important role is played by the form of meningitis, the timeliness and adequacy of therapeutic measures. Headaches, intracranial hypertension, epileptic seizures, visual and hearing impairments often remain as residual symptoms after tuberculous and purulent meningitis. Due to the late diagnosis and resistance of the pathogen to antibiotics, the mortality rate from purulent meningitis (meningococcal infection) is high.

Prevention

As preventive measures to prevent meningitis, regular hardening (water procedures, sports), timely treatment of chronic and acute infectious diseases, as well as short courses of immunostimulating drugs (eleutherococcus, ginseng) in the foci of meningococcal meningitis (kindergarten, school, etc.) are provided.

The human brain is one of the most protected organs. If the heart is "protected" only by the chest and ribs, which are easy enough to break, then the main center of regulation of all processes is guarded by the hardest bones: the cranial and spinal column. It is no coincidence that nature created the body in this way: any diseases of the brain are extremely serious and dangerous to life, the safety of motor and intellectual functions. It is important for anyone to know the symptoms of meningitis, as this disease is often fatal.

What is meningitis

Among infectious diseases, meningitis occupies a special place. On the one hand, the disease cannot be called common, most people have never encountered it, they are unlikely to be able to name friends or relatives who would have to be treated for it. On the other hand, the disease is still considered one of the most life-threatening, mortality without properly selected therapy is up to 80%.

Before the invention of immunization methods, meningitis was practically a death sentence: children died from it in 98% of cases, and adults - in 90%. Unfortunately, even modern drugs are not a panacea: with timely and completely correct treatment, mortality reaches 10% and another 30% remain disabled for the rest of their lives.

The disease is provoked by specific pathogens, including:

• meningococci;
• pale treponema - the causative agent of syphilis;
• spirochetes from the genus Borella;
• bacilli of the genus Brucella;
• toxoplasma.

Among these microorganisms, meningococci are the most dangerous, since this infection has a pronounced contagiousness - the ability to transmit to healthy individuals. Epidemics of meningitis are described, which were usually provoked by this particular bacterium.

In other cases, the disease develops due to disturbances in the normal functioning of the body. The meninges are completely sterile, but if for some reason bacteria get inside, this leads to the development of the disease. There are cases when meningitis became a complication of less severe infections - tonsillitis, tonsillitis, pharyngitis, otitis media, rhinitis due to the proximity of the ear-nose-throat organs to the brain.

There are viral forms of the disease. Most of the viruses that cause encephalitis and meningitis are rare in our country, as they are common in the hot climate of Africa and South America. Among such viruses, we know tick-borne encephalitis, which is often accompanied by meningitis, as well as the enterovirus form.

Of all the forms of meningitis, the most dangerous is amoebic, caused by Fowler's negleria. This type of disease is practically not treatable, and in 99% of cases ends in the death of the patient. There are no specific drugs. Amoebic meningitis is very rare, the habitat of Fowler's negleria is North and South Africa.

Causes of meningitis

An infectious disease is provoked by various pathogens. The symptoms of meningitis will also depend on the specific bacterium, virus, or microorganism. Depending on the way microorganisms, fungi or other harmful agents enter the meninges, there are primary and secondary forms of the disease. The first means that the disease developed independently, the second - that it appeared as a complication of another infection. The following types are distinguished depending on the reasons:

1. Serous or viral - provoked by a virus. Enteroviral meningitis is the most common. As the name implies, the pathogen first enters the gastrointestinal tract. It is highly contagious, at risk are children, the elderly, people with weakened immune systems. Contagiousness increases in crowded places, so outbreaks are common in children's camps and schools. In spring and summer, the virus is more active.
2. Bacterial meningitis - this concept means, as a rule, the most common form of the disease, provoked by a specific pathogen, meningococcus. Also, this type of pathological process is known as purulent. Contagiousness is high, there may be epidemiological outbreaks. It is transmitted from person to person through contact, using common objects.
3. Infectious meningitis - caused by non-specific bacteria agents. Most often it develops as a secondary type with untimely or incorrect treatment of bacterial respiratory infections. It often becomes a dangerous complication of pneumonia. Relatively harmless.
4. Tuberculous meningitis could be considered a special case of a secondary form of the disease, but it differs in its characteristics. In some cases, it manifests itself as the primary type of the disease. Mycobacterium tuberculosis is characterized by a high ability to damage all tissues and organs. At risk - cancer patients, HIV-infected, persons suffering from chronic beriberi.
5. Protozoal meningitis or toxoplasmosis. It is caused by the protozoan genus Toxoplasma. This type differs in that in mild cases it does not lead to death and even noticeable symptoms, but it can significantly change the behavior and personality of a person. Some experts believe Toxoplasma is the cause of schizophrenia. Transmitted in cat urine.

The common cause of each type of disease is contact with pathogenic bacteria, viruses or protozoa. Another important factor is the lack of the body's defenses, so children are more likely to get sick, whose immune system does not effectively protect against the penetration of dangerous agents into the meninges. Symptoms in adults may be less pronounced, the course is easier.

The primary type is difficult to miss, because the disease manifests brightly, with a set of characteristic symptoms of meningitis. Some doctors consider the secondary form more dangerous in terms of prognosis, the mechanism of the disease is as follows:

• development of the underlying disease;
• the patient is inattentive to appointments;
• the primary infection appears to be cured;
• part of the bacteria survives, forms a defense against drugs, penetrates the meninges.

Symptoms of meningitis in this case appear against the background of a weakened immune system, and often antibiotic resistance is also added. That is why it is so important to adhere to the course of treatment and be attentive to the appointments of a specialist, even if we are talking about banal rhinitis.

Symptoms and signs

Symptoms and signs of meningitis may vary depending on the age of the patient, the form of the disease, the severity of the pathological process. It is believed that the symptoms in adults are weaker, and in children, especially babies under one year old, a fulminant (lightning-fast) picture of the disease often develops, which almost always ends in death.

The enterovirus type begins with intestinal symptoms and is usually mistaken for food poisoning in the early stages.

However, the disease develops rapidly, characterized by the following symptoms:

• a sharp rise in temperature to 40 degrees and above;
• vomiting that does not bring relief;
• intense headache;
• hyperesthesia - increased tactile sensitivity;
• myalgia.

A characteristic sign of this type of disease is a peculiar position of the body in bed, known as the “pose of a pointing dog”. This sign of meningitis is due to the fact that the peripheral nervous system is affected.

Bacterial meningitis

Symptoms of meningitis when affected by specific cocci differ, although not too much. The disease is characterized by:

• high temperature - also up to 40 degrees;
• clouding of consciousness, up to sopor;
• convulsions;
• vomit;
• unbearable headache;
• photophobia.

Skin rashes are also a characteristic symptom. They indicate the specific type and pathogen.

Secondary infectious

Symptoms in adults appear more often than in children, as a rule, are associated with insufficiently effective treatment. Signs of secondary meningitis:

• acute headache;
• heat;
• convulsions;
• neck stiffness.

Rashes are not observed. The form will differ in that the development is slow, the prodromal period is up to 2 weeks.

Toxoplasmosis or the protozoal form, unlike the others, can go unnoticed for years. Symptoms of meningitis are practically absent, with the exception of episodic headaches, to which the patient does not pay attention, but the character of a person changes, he becomes neurotic, frivolous, attention and ability to concentrate are disturbed.

Watch the video what is important to know about meningitis in the first place:

Prevention

Some forms of the disease can be prevented. The most effective vaccination against meningitis helps children, although vaccination is allowed only from 3 months. Vaccination is mandatory in regions with an unfavorable epidemiological situation. Also, a meningitis vaccine can be included in the measles and rubella complex, in which case it prevents the serous appearance. Among the preventive measures will always remain personal hygiene, avoiding contact with the sick and crowded places.

Treatment in children

Children are very difficult to tolerate the disease. If the symptoms in adults often take a mild course, then children almost always develop acute or subacute types. Treatment includes:

1. Antiviral drugs in the case of the serous form. It must be understood that there are no specific drugs, only interferon injections are prescribed, which help the body, but do not destroy viral agents by themselves.
2. Antibiotics - are always prescribed, drugs of the cephalosporin group are effective. Infusion infusion, intravenously. Isoniazid - for tuberculosis.
3. Diuretics - to remove excess fluid that can cause swelling of the brain. At the same time, plenty of fluids are recommended to avoid dehydration.
4. Detoxification therapy - glucose solution, saline solutions that restore blood plasma.
5. Steroid drugs.
6. Pressor amines to prevent the development of shock.

Therapy should be carried out only in a hospital under the supervision of doctors. Without recourse to specialists, mortality in children can reach 95%.

Treatment in adults

Therapy in adults does not differ in its scheme from that in children, adjusted for the patient's body weight and the severity of the disease. It is also forbidden to self-medicate or attempt to transfer "on the legs". The scheme usually includes:

1. Antibiotics of several groups. In addition to cephalosporins, adults are prescribed ampicillin. This is a rather toxic drug that often causes skin rashes even without a severe allergic reaction, so it is rarely administered to children.
2. Cephalosporins have always been the mainstay of therapy for meningitis. The dose increases depending on body weight and the severity of the course of the disease. The most effective drugs of the third and fourth generation.
3. Carbapenems are another antibiotic with a broad bactericidal spectrum. It is administered not only to combat the main pathogen, but also to prevent possible side infections.
4. Glucocorticosteroids - steroid therapy is almost always carried out in order to alleviate the patient's condition, reduce swelling, pain in the lesions.
5. Diuretic and detoxification therapy - permanent. The meaning of these measures is to remove the infected fluid, lymph and pus, replacing it with new blood plasma. Adults and children in severe cases are given plasma transfusions.

Meningitis - one of the most severe acute infectious diseases. In 70% of cases, it is acute, the patient is urgently hospitalized, where they carry out all the necessary measures. Knowing the symptoms will help to recognize and assess the severity of the condition in time. It must be remembered that there are no traditional methods of treatment. Also, we must not forget that meningitis is a contagious disease, so a frivolous attitude to one's condition is dangerous not only for the patient, but also for others.

Izvozchikova Nina Vladislavovna

Gastroenterologist, Infectionist, Pulmonologist

Experience: 36 years

1975-1982, 1 MMI, san-gig, highest qualification, infectious disease doctor

Meningitis is an inflammatory process in the pia and arachnoid membranes of the brain and spinal cord. This is a serious infectious disease caused by various pathogens.

Despite the large arsenal of antibacterial agents, meningitis remains one of the most terrible infections, when such a diagnosis is established. the patient needs immediate hospitalization, since the consequences of untimely treatment of meningitis can be the most deplorable, the percentage of deaths is also high.

What are meningitis

Meningitis is classified:

1. According to the pathogen that caused them: bacterial, viral, fungal, rickettsial, protozoal.
2. By the nature of inflammation: serous, purulent, mixed.
3. According to the severity of the course: light, moderate, severe.
4. According to the rate of development: fulminant, acute, subacute, chronic.
5. By the prevalence of the process: diffuse, limited.
6. According to the source of infection: primary, when meningitis develops without an obvious primary source of infection; secondary, when the infection penetrates from another identified focus (mainly purulent).

How does meningitis develop?

In order for inflammation of the meninges to develop, the pathogen must somehow get inside the skull. Most often, it gets there with the bloodstream in infectious diseases (, dysentery, typhoid fever), as well as in the presence of any purulent focus in the body (, abscess, endocarditis, infected wound or burn). The infection can also penetrate the meninges through the regional lymph flow, through the sheaths of the nerves or by contact in the presence of a purulent focus in the head area (purulent, periostitis, paratonsillar abscess, osteomyelitis, purulent skin lesions, especially in the forehead, scalp and nasolabial triangle) , as well as traumatic injuries of the skull.

Almost any infectious agent can become the causative agent of meningitis. Most often it is a virus of influenza, measles, mumps, herpes,. Of the bacteria, these are pneumococci, meningococci, tubercle bacillus. Under certain conditions, meningitis can be caused by fungi and protozoa.

Obviously, the penetration of infection into the membranes of the brain and the development of inflammation in them is possible under a certain state of the immune system. Probably the existence of certain congenital defects in immunity, which are conducive to the development of this disease.

When the pathogen enters the cranial cavity, it settles on the meninges, an inflammatory reaction begins here - edema, hypersecretion of cerebral cerebrospinal fluid, a violation of its outflow. The membrane swells, intracranial pressure increases, irritation of the meninges and compression of the cranial and spinal nerves. There are clinical symptoms: menningial, cerebral, and general intoxication of the body is progressing.

With a purulent process, there is an accumulation of pus in the subshell space, foci of softening in the cerebral cortex, microabscesses. Purulent exudate can cover the entire brain, or be located only in the furrows. Obviously, with such a course of meningitis, even if recovery occurs, its consequences are irreversible.

Clinic of meningitis

Despite the variety of causes, the clinical picture of meningitis is usually typical for all forms. The acute form is especially similar in symptoms and usually does not cause difficulties in diagnosis. The main symptoms of meningitis, the combination of which allows you to make a diagnosis:

The severity of these signs of meningitis depends on the severity of the process, some of them may be mild or not detected at all with sluggish and erased forms of the disease.

In young children (up to a year) The first signs of meningitis may be nonspecific. There is hyperthermia, anxiety, constant monotonous crying, regurgitation, convulsions. Only on the 2-3rd day meningeal symptoms and impaired consciousness appear.

Consider the most common forms of meningitis.

Epidemic meningococcal meningitis

60-70% of all bacterial meningitis is caused by meningococcus. Its danger is that such meningitis proceeds very hard, often, especially in children, there is its fulminant course, leading to death within a few hours. Infection occurs from a sick or latent carrier. Infection occurs by airborne droplets, which is why it is also called epidemic meningitis.

When infected, meningococcal nasopharyngitis develops first, which differs little from the usual signs: redness and swelling of the mucous membrane of the pharynx, pharynx, runny nose.

Infection with meningococcus does not always cause the development of meningitis. It all depends on individual defenses. If the body is not able to create a barrier for it at the stage of nasopharyngitis, the pathogen enters the brain with blood flow and after a few days (from 1 to 5) a clinic of purulent meningitis develops (acute onset, severe course).

It is meningococcal meningitis that causes a fulminant form in children: the most acute course, with the development of meningococcal sepsis (high concentration of meningococcus in the blood - meningococcemia). Under the influence of toxins, the formation of microthrombi occurs, hemorrhages in all organs and the child dies. A formidable symptom of meningococcemia is a hemorrhagic rash on the skin.

With timely treatment there is a high probability of complete recovery, since meningococcus is perfectly treated with ordinary old penicillin.

Other purulent meningitis

Staphylococcal, pneumococcal, caused by have a higher mortality rate and irreversible consequences, since these pathogens have for the most part developed resistance to existing antibiotics.

Untreated purulent meningitis leads to death in 50% of cases. The most severe form of meningitis is named reactive meningitis. This is a bacterial meningitis with a fulminant course, caused mainly by meningococci, streptococci, pneumococci. It can be either primary or secondary. This form leads to death in 90% of cases. In adults, death occurs within 1-2 days, children die within a few hours.

Serous meningitis

Serous meningitis is mainly seasonal-epidemic. Children get sick more often. Most often, serous meningitis is caused by enterovirus and mumps virus.

Such meningitis is distinguished by less pronounced meningeal symptoms and a relatively benign course.

Tuberculous meningitis

Recently, this form of meningitis has become much more common. Such meningitis is always secondary, complicating the course of the tuberculous process in another organ (mainly the lungs). It develops subacutely against the background of the progression of the disease. There is a gradually increasing headache, general weakness, nausea, fever.

Meningeal symptoms also appear gradually, after 7-10 days from the onset of the disease. Damage to the cranial nerves is characteristic, which is manifested by double vision, ptosis and strabismus.

Changes in the cerebrospinal fluid are more often of a serous nature, in 2/3 of cases Mycobacterium tuberculosis is detected by microscopy.

Treatment of meningitis

Any suspicion of meningitis requires immediate hospitalization and urgent lumbar puncture to clarify the diagnosis.

Antibiotic therapy is the main treatment for meningitis. The choice of antibiotic depends on the type of pathogen. With purulent meningitis, treatment begins with high doses of penicillin, which is administered intravenously. Perhaps a combination with other antibiotics (gentamicin, cephalosporins, kanamycin). Upon receipt of the results of a bacteriological examination of the cerebrospinal fluid, antibiotic treatment is carried out, to which the isolated pathogen is sensitive.

In viral meningitis, treatment is mainly symptomatic, since effective antiviral drugs do not exist.

Tuberculous meningitis is treated with specific anti-tuberculosis drugs.

Non-specific treatment:

In addition to antibiotic therapy, the following are used to alleviate the condition:

• Diuretics for the treatment and prevention of cerebral edema.
• Glucocorticoid hormones.
• Plasma substitutes, saline solutions.
• Intravenous glucose solution.
• Cardiovascular drugs according to indications.

With secondary meningitis - treatment of the underlying disease. If meningitis was a complication of purulent inflammation of the ENT organs or the oral cavity - immediate surgical sanitation of the focus (opening an abscess, drainage of the paranasal sinuses, middle ear cavity, etc.).

Consequences of meningitis

There are many "horror stories" that after suffering meningitis, consequences for life are sure to remain. This is far from true.

If treatment is started on time, meningitis can pass without any unpleasant consequences, which in most cases is observed.

In a small percentage of cases, increased fatigue, headaches, which will intensify with changes in atmospheric pressure, difficulty in remembering information, absent-mindedness, and sleep disturbance may remain. However, these symptoms usually disappear gradually within 5 years.

Even more rarely, when severe purulent forms of meningitis affect the very substance of the brain, visual impairment, hearing impairment, convulsive seizures, and a significant mental retardation may remain.

Prevention of meningitis

No one is immune from meningitis. But meningitis has favorite ages:

• Children under 5 years old, and boys get sick 2-3 times more often than girls.
• Young people 16 - 25 years old.
• Elderly people over 60 years old.

You need to know the basic rules that will help minimize the risk of infection, prevent the complicated course of other diseases, and also start the treatment of already developed meningitis on time. It must be remembered that meningitis is treatable and the sooner treatment is started, the better the outcome.

Video: meningitis in children, “School of Dr. Komarovsky”